*self Employed Borrower(s) may be
required to provide additioanal documentation such as tax returns and
financial statements.

B/C

Describe Other Income Notice:

Alimony, child support, or separate maintenance
income need not be revealed if the Borrower(b) or Co-Borrower(c) does
not choose to have it considered for repaying this loan.

Monthly Amount

$

$

$

VI. ASSETS
AND LIABILITIES

This Statement and any applicable supporting
schedules may be completed jointly by both married and unmarried
Co-Borrowers if their assets and liabilities are sufficiently joined so
that the statement can be meaningfully and fairly presented on a combined
basis; otherwise separate Statements and schedules are required. If the
Co-Borrower section was completed about a spouse, this statement and
supporting schedules must be completed about that spouse aslo.

completed
Jointly Not Jointly

Assets

Cash or Market

Description

Value

Cash deposit toward puchase held by:

$

List checking and savings
accounts below

Name and
address of Bank, S & L, or Credit Union

Name: Street:
City: State, Zip:

Acct.no.

$

Name and
address of Bank, S & L, or Credit Union

Name: Street:
City: State, Zip:

Acct.no.

$

Name and
address of Bank, S & L, or Credit Union

Name: Street:
City: State, Zip:

Acct.no.

$

Name and
address of Bank, S & L, or Credit Union

Name: Street:
City: State, Zip:

Acct.no.

$

Stocks & Bonds
(Company name/number& description)

$

Life insurance net cash value

Face amount: $

$

Subtotal Liquid Assets

$

Real estate owned (enter market
valueschedule of real estate owned)

$

Vested interest in retirement fund

$

Net worth of business(es)
owned(attach financial statement)

$

Automobiles owned (make and year)

$

Other assets (itemize)

$

Total Assets a.

$

Borrower's Signature:

Date

X

Liabilities and
Pledged Assets. List the creditor's
name, address and account number for all outstanding debts,
Including automobile loans, revolving charge
accounts, real estate loans, alimony, child support, stock pleges,
etc, use continuation sheet, if necessary. Indicate
by (*) those liablities which will be satisfied upon sale of real
estate owned or upon refinancing of the subject
property.